Lancet Examines Effects of HIV-1 on Maternal and Child Health in Africa in Second of Five-Part Series

In the June 15 issue of the Lancet, Drs. Francois Dabis of Universite Victor Segalen in France and Ehounou Rene Ekpini of Project RETRO-CI examine the effects of HIV-1 on maternal and child health in Africa in the second installment of a five-part series on AIDS in Africa. Women of childbearing age represent 55% of sub-Saharan Africa's adult HIV-positive population, and they generally become infected "early in their reproductive years." Women can pass the virus on to their infants during pregnancy, delivery and breastfeeding. Although disease progression can lower fertility, pregnancy and breastfeeding rates are not greatly affected by HIV and remain high among HIV-positive African women. The cumulative transmission rate of HIV from mother to child is 25% to 45% in the region, and about 1,900 children each day are infected with HIV-1 by their mothers in sub-Saharan Africa. The authors state that this rate can be lowered through several interventions, including the prevention of HIV transmission among women of childbearing age, the reduction of unwanted pregnancies by HIV-positive women who are aware of their serostatus and antiretroviral-based interventions. Currently, only 13 African nations offer antiretroviral treatment to reduce the odds of mother-to-child HIV transmission, reaching less than 3% of HIV-positive African women. Such programs are the "most cost-effective" antiretroviral interventions available and are "one of the most attractive" HIV prevention interventions, the authors note, adding that a "rapid scaling-up" of such programs is "crucial" to lowering the number of pediatric HIV/AIDS cases. Without such treatment programs, as well as programs to treat HIV-positive parents, child mortality will continue to climb, as will the number of African AIDS orphans, the authors state, concluding, "Prevention of mother-to-child transmission should become a universal standard of care in Africa, and research should continue to reduce the transmission risk to well below 5%" (Dabis/Ekpini, Lancet, 6/15).